Through a telemedicine partnership arranged between ValueOptions, Verizon, and Tandberg, the David Lawrence Center (DLC) of Naples, Fla., is now delivering telepsychiatry services to residents of Imokalee. Imokalee is an agricultural community located about 45 miles from Naples and the state's southern Gulf Coast.

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According to Patrick Glynn, the ValueOptions vice president who heads the payer's Tampa Service Center, ValueOptions led the telepsychiatry pilot effort to evaluate the technology's ability to expand patient access statewide. "Access to care isn't just about distance or geography, but about accessibility to a relatively small pool of psychiatrists and clinical specialists who are needed to provide care over a wide area," says Glynn. "Telepsychiatry is a very exciting move in that direction."

ValueOptions sought to develop the pilot telepsychiatry program with DLC--one of its many provider partners--to resolve care access concerns in Collier County, which extends inland from the Gulf Coast to remote agricultural areas at the northern end of the Everglades. DLC had a satellite office in Imokalee, a community of 20,000 primarily agricultural workers where few had access to reliable transportation (DLC's Naples office was an hour's drive away) and medical facilities were limited. Providers were also limited, and language barriers were common, since most adults speak Spanish or Haitian Creole, not English.

According to Bonnie Fradeen, COO at DLC, "We got involved because ValueOptions, our prepaid Medicaid provider for many child and some adult services, approached us. Collier County is very large and Imokalee, where we have an office, is a community with a lot of needs for physician, clinical, and therapeutic care."

For several years, DLC had relied on a handful of Spanish and Creole speaking staff from Naples to travel to Imokalee to provide a range of care, including medication management and therapy for both adults and children.

Setup: New workflows needed

After agreeing to the pilot, Fradeen says that "the things that had to happen to deliver the service involved new workflows. We had to consider, 'How are we going to coordinate both ends--getting the client and the physician where they needed to be? How are we going to support e-prescribing for controlled substances? Who's going to help the patient get set?' And, we had to put in the resources to make that happen." In all, the workflow development took about six weeks of work.

From the outset, Fradeen could see the value of the effort, since the availability of telepsychiatry meant that many details of service at Imokalee, once handled by traveling physicians, could now be performed by case managers or support staff. "It's much more efficient to have these personnel on the road ... than having a physician on the road at a much higher rate."

Glynn adds that, early on, all involved in the pilot were concerned about whether there would be any "fear factor" among physicians or patients about using the service. Would the technology pose any obstacles or impediments to treatment compared to an in-person appointment?

"Our biggest concern was for the doctors--they're on a rigorous schedule," says Fradeen. "So, we needed to have equipment that was going to work very well--no problems. It had to be high-definition, as though you were looking into someone's eyes--and it was."

Practical considerations

But the evaluation didn't stop there. Fradeen and her DLC colleagues considered the technology's requirements and benefits over a range of factors and talked weekly with the ValueOptions team to assess the progress of the pilot. Among the financial and service issues considered by the partners were:

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